A new virus has caused 9 deaths; has SARS left us able to contain it?

A new virus emerged nearly a year ago in Jordan, predominantly infecting people who live in or have traveled to the Middle East. Two days ago, the World Health Organization confirmed the fifteenth case of infection with the novel coronavirus—a family of viruses that includes both the common cold and SARS—and a fatality that brought the death count to nine. The World Health Organization has been monitoring the situation closely and has been working with agencies in member states, such as the Center for Disease Control, to better understand the public health risk posed by the virus.

Ten years ago, the SARS outbreak spurred efforts by the World Health Organization to improve global responses to health threats and crises. In November 2002, a middle-aged man went to the hospital in Foshan, China with what appeared to be pneumonia. The man recovered and returned home. It would have been an unremarkable event, except for the fact that it was likely to have been the first case of severe acute respiratory syndrome, or SARS.

Others were infected with the mystery virus, but it didn’t come to the world’s attention until February 21, 2003, when a professor of nephrology from a neighboring municipality traveled to Hong Kong. Shortly after his arrival, he realized he had the same symptoms of the patients he had been treating, so he checked himself into the local hospital. He died 11 days later.

In the wake of his death, others fell ill and took the virus with them on their travels. On March 12, 2003, the World Health Organization issued a global alert. By the beginning of April, Hong Kong reported 685 cases and 16 deaths, and the epidemic was spreading. Eventually the virus spread to Asia, North America, South America, and Europe, infecting more than 8,000 people and killing 774.

The epidemic not only renewed the debate about how countries should cooperate to combat international public health crises, but it also proved to be a success in collaboration across borders. Thirteen laboratories in 10 countries labored to identify and sequence the virus' genome, which was accomplished within a month. The World Health Organization’s Global Outbreak Alert and Response Network analyzed case reports from all countries affected by SARS in real time and helped guide management and infection control. Thanks in part to these efforts, the outbreak was declared contained by July 2003.

The rapid spread of SARS was a turning point in the World Health Organization’s International Health Regulations. Previously, the regulations had focused on just three infections diseases: cholera, pneumonic plague, and yellow fever. But the outbreaks of SARS in 2002 to 2003, then avian influenza in 2004 to 2005, lead to a revised set of International Health Regulations put in place in 2005.

The revisions provided the world with the legal framework to mount a collective defense against global threats to human health. Changes included increased mandatory reporting for a number of illnesses, better surveillance and response, and ensuring that ports of travel between countries have measures in place to prevent the spread of disease.

In a "Perspective" article published today in the journal Science, Isabelle Nuttall and Christopher Dye of the World Health Organization ask if the revisions to the International Health Regulations are adequate. “The critical test comes not from scrutiny of the legislative fine print but from the way the regulations work in practice,” they write.

The H1N1 flu pandemic of 2009 has been the biggest test so far. During the outbreak, a report reviewing how well the International Health Regulations are functioning found that the new regulations allowed for better preparation. Still, the world remained ill-prepared for a pandemic of this magnitude, or any large global, sustained threat to public health. Challenges exist today: national and local capacities called for in the regulations are still not up to standards, national legal arrangements are not always consistent with international laws, and member states still worry about maintaining their reputations when divulging information about outbreaks.

Out of 195 signatories, 119 did not meet last June’s deadline to implement core competencies to detect, assesses, inform, and respond to public health threats. Instead, those 119 asked for an extension.

The authors postulate that the novel coronavirus serves as a reminder of the threat posed by SARS a decade ago. While we cannot know what, where, or when, another major international health threat is inevitable—will we be fully prepared?

"The World Health Organization’s Global Outbreak Alert and Response Network analyzed case reports from all countries affected by SARS in real time and helped guide management and infection control."

Now what does that mean? How did they control it? I'm a biologist but really don't know how 685 cases didn't lead to everyone on the planet being wiped out. How did they stop it? Did it burn out, as g0m3r619 suggests? For that matter, how does an infection "burn itself out"?

Did it burn out, as g0m3r619 suggests? For that matter, how does an infection "burn itself out"?

IANAE, but extreme mortality can cause this, right? If people die before it can spread, the infected population should just dwindle down.

Yes, if the population is contained/isolated. Like Ebola - super nasty and people get quite ill, quite quickly so don't feel like getting on a plane/getting out of bed. The opposite is HIV infection - a real slow burner. But don't SARS and other flu hybrids/mutants sit in the middle?

Having spoken to one of the people involved in this, I can tell you that "management and infection control" isn't what stopped SARS. SARS stopped SARS because every time it was transmitted from person to person, its virulence decreased for reasons unknown. People who were initially infected were vastly more likely to die than those who were infected several generations down the line. While our response may have helped, this bizzare loss of virulence was ultimately what killed SARS.

Don't worry though - there are plenty of similar viruses in bats in China to infect us.

Having spoken to one of the people involved in this, I can tell you that "management and infection control" isn't what stopped SARS. SARS stopped SARS because every time it was transmitted from person to person, its virulence decreased for reasons unknown. People who were initially infected were vastly more likely to die than those who were infected several generations down the line. While our response may have helped, this bizzare loss of virulence was ultimately what killed SARS.

Don't worry though - there are plenty of similar viruses in bats in China to infect us.

Thanks TD - that makes sense with what I know from colleagues working on intestinal infections - although they were bacterial rather than viral. To maintain virulence of the bacteria, which was a mouse pathogen, they had to passage through mice. If they did so in tissue culture the bacteria lost virulence. So I guess that host factors permit the organism to maintain these "virulence factors". Viruses have very small genomes and take advantage of overlapping reading frames i.e. the same stretch of DNA/RNA encodes different proteins, depending upon when you start the reading frame, and I guess that this makes species hopping a bit tougher. Not, of course, that this is a reason to be complacent, and thanks to the revolutions in gene sequencing we are better placed than ever to pick these things up early. But your warning about bats is quite true. Note to self: At all costs, avoid eating bat poo.

Between new infections from novel sources and resistance in previous ones, WE"RE DOOMED. (kidding)We will evolve new endogenous resistance, new agents will be attenuated, and science will help with new therapy modalities. Though some of these could kill significant numbers of people before it runs its course (if its someone you care about, 1 is a significant number).

As a health care professional the one that scares me is multiple antibiotic resistant TB.

This is such fucking bullshit meant to scare the stupid public who actually believe this shit.

According to the CDC, an average of 36,000 people die of the regular flu every year. Shouldn't that be a Pandemic in itself?

The only winners are the Pharmas who make a shit load of money from selling vaccines to the unsuspecting public every time one of these "Pandemic" stories hits the news.

Yes, it is, actually. The flu is the biggest enemy of the CDC, which is why they're always harping on it. The idea that this is a pharma conspiracy is born out of the fact that you are too young to remember the days when disease was the greatest killer of humanity.

Humans, in the 20th century, destroyed smallpox and nearly destroyed polio. Many other terrible diseases have been beaten back, and the retard anti-vaccination people (along with some third world countries) are the only reason they aren't entirely gone.

But the flu has animal reservoirs and thus is very difficult to completely eradicate. Its actually a pretty bad disease, but its not as bad as many others are. The CDC is locked in never-ending battle with it, and the flu shot does usually help. Someday we may come up with even better ways of fighting it.

SARS is pretty dangerous. SARS only died because of SARS, and the CDC, while it will take a victory via luck, will not rely on it. So the idea that worrying about coronaviruses, ebola, marburg, ect. are overblown is kind of silly. There's a good reason that we worry about such things.

HIV, influenza, and malaria are the big three, with drug resistant TB, coronaviruses, ebola, marburg, ect. all being things that they keep an eye on.

The real problem is that most people don't really understand epidemiology, and there are some morons who don't understand just how dangerous diseases really are (both very and less so than is commonly believed, at the same time no less).

This is such fucking bullshit meant to scare the stupid public who actually believe this shit.

According to the CDC, an average of 36,000 people die of the regular flu every year. Shouldn't that be a Pandemic in itself?

The only winners are the Pharmas who make a shit load of money from selling vaccines to the unsuspecting public every time one of these "Pandemic" stories hits the news.

'Ordinary' influenza is relatively easy to handle and mortality rates are relatively low, especially where vaccines are available. Then there are outliers. like the Asiatic, Spanish, Asian and Hong Kong Flu. Of those, the Spanish Flu alone infected a third of the world's population and killed at least 70 million. So, its mortality rate wasn't really comparable to the very minor flu that might keep you off your food for a week.

It is the outliers that are the reason we need to be alert to potential new diseases. The population of the world is far greater, and massively more interconnected than it was in 1918-19 when the Spanish Flu killed so many (you can thank WW1 for that with an unusual amount of people movement for the time), so if something with a very high infection rate gets out it can get very ugly very quickly.

Just because SARS, Avian and Swine flu didn't kill vast numbers doesn't mean we should be complacent. Vaccines are preventative. If people don't catch the disease they're not going to spread it, which is a Good Thing (tm)

Imagine if one of the recent outbreaks did start killing millions. I bet you'd be in line for your vaccines and antivirals then, big pharma or no.

Allie Wilkinson / Allie is a freelance contributor to Ars Technica. She received a B.A. in Environmental Studies from Eckerd College and a Certificate in Conservation Biology from Columbia University's Earth Institute Center for Environmental Sustainability.